Four speech problems are usually created by cleft lip and palate deformity. Retardation of consonant sounds u is the most common finding. Because consonant sounds are necessary for the development of early
vocabulary much language activity is omitted. As a result, good sound discrimination is lacking by the time the palate is.closed. Hypernasality is usual in the patient with a deft of the soft palate and may remain after surgical correction. Dental malformation, ‘malocclusion, and abnormal
tongue placement may develop before the palate is closed and thus produce an articulation problem. Hearing problems contribute significantly to the many speech disorders common in patients with oral clefts. In the normal individual, speech is created by the following scheme. Air is allowed to escape from the lungs, pass through the vocal cords, and enter the oral cavity. The position of the tongue, lips, lower jaw, and soft palate working together In a highly ‘coordinated fashion results in the sounds of speech being produced. If the vocal cords are set hlto ‘vibration while the airstream is passing . between, then voice is superimposed on the speech sounds that result from the relationships of the oral structures
The soft palate is raised during speech production, preventing air from escaping through the nose. . For clear speech it is necessary for the individual to have complete control of the passage of air from he oropharynx to the nasopharynx. The hard palate provides he partition between the nasal and oral cavities. The soft palate functions as an important valve to control the distribution bf escaping air between the oropharynx and nasopharynx (Fig. 27-7). This is called the velopharyngeal mechanism (velo means soft palate). As the name Implles, its two main components are (1) the soft palate and (2) the. pharyngeal walls. When passive the soft palate hangs downward toward the tongue, but during
.. speech the muscles of the soft palate elevate it and draw it toward the posterior pharyngeal wall, Which is what happens to the normal individual’s soft palate when he or she is asked to say IIah.” In normal speech this action
takes place rapidly and with an unbelievable complexity, so that the valvlng mechanism can allow large amounts of air to escape into the nasopharynx or can limit the escape to none. . In individuals whose soft palate is cleft, the velopharyngeal mechanism cannot function because of the discontinuity
of the musculature from one side to the other, The soft palate thus cannot elevate to make contact with the pharyngeal wall. The result of this constant escape of air into the nasal cavity is hypemasal speech. Individuals with cleft palate develop compensatory velopharyngeal, tongue.rand nasal mechanisms in an , .attempt to produce intelligible speech. The posterior and lateral pharyngeal walls obtain .great mobility and attempt to narrow the .passageway between the oropharynx and nasopharynx during speech. A muscular bulge of the pharyngealwall actually develops during attempts at closure of the passagewayin some individuals with cleft palate and is known as Passavant’s ridge or bar. Individuals with cleft palates develop compensatory tongue postures and positions during speech to help valve their coming from the larynx into the pharyngeal areas. Simllarly,
the superficial muscles around the nose involved in facial expression are recruited to help limit the amount of air escaping from the nasal cavity. In this instance the valving is .at the other end of the nasal cavity from the
velopharyngeal mechanism. However, in an uncorrectedcleft of the soft palate, it is literally impossible for compensatory mechanisms to produce a satisfactory velopharyngeal mechanism. Unfortunately in surgically corrected soft palates, velopharyngeal competence is not always achieved with one operation, and secondary procedures are frequently necessary.
Speech pathologists are well versed in assisting children with cleft deformities to develop normal articulation skills. The earlierIn life speech training is started in patients with cleft deformities, the better the eventual
outcome. The patient may need to undergo speech counseling for several years to produce acceptable speech. When hearing problems are also present, the speech problems are compounded. Hearing loss at an early age is especially detrimental to the development of normal speech skills. The child who is unable to hear is unable to imitate normal speech. Thus the parents must be cognizant of their child’s development and ensure that regular visits to the pediatrician are undertaken.